Obstetric Injury Research Articles

Perinatal Risk Factors Associated With Intrapartum Perineal Injuries At The Korle Bu Teaching Hospital

Background: Obstetric perineal injury is a major contributor to women’s reproductive health problems. More than 60% of women suffer varying degrees of obstetric perineal injuries during vaginal delivery requiring repair. This study determined the risk factorsassociated with perineal injury. Method: Prospective observational study of 356 women who had singleton term vaginal delivery between 1stApril and 31stMay, 2018 at the KBTH. Sociodemographic and clinical data of participants were collected and analysed to determine association betweenvariables. A p-value of <0.05 was considered statistically significant.Results: Two hundred and thirty-six women (66.29%) had vaginal deliveries with no perineal injuries comprising 81 primiparous and 155 multiparous women. Perineal injury among the study participants were 120/356 (33.71%) while perineal injury for first degree, second degree, third degree and fourth degree were 75/356 (21.07%), 41/356 (11.52%), 2/356 (0.56%), 2/356 (0.56%) respectively. A total of 948 vaginal deliveries was conducted during the study period. The odds of developing a perineal injury was 8 times higher among participants with previous surgery on genital tract (OR, 8.29 [95% CI 2.69- 25.6]; p<0.001) and 18 times higher among participants with previous postpartum complication (OR, 18.00 [95% CI 4.06-79.71], p<0.001). Babies with birth weights ≥2.5kg had 4.11 increased odds of developing perineal injury when compared to those with birth weights <2.5kg (OR, 4.11 [95% CI, 1.70-9.98] p=0.001). Vacuum delivery was strongly associated with a 4.81 odds perineal injury (OR, 4.81 [95% CI, 1.22-18.9] p<0.014).Conclusion: The incidence of perineal injury among women who had vaginal delivery at the KBTH maternity during the study period of (12.66%) was high compared to other studies from the West African Subregion. Risk factors such as previous postpartum complication, episiotomy, and gestational age at delivery, head circumference of the baby, asthma, hypertension and past genital tract surgery weresignificantly associated with perineal injury. Early identification of women at risk of perineal injury could help with interventions to reduce the incidence of this complication during childbirth.

Biofeedback therapy for anorectal functional disorder: Malaysian colorectal tertiary centre experience

BackgroundAnorectal functional disorder encompasses arrays of conditions including Obstructive Defecation Syndrome (ODS) and Fecal Incontinence (FI). Biofeedback Therapy (BFT) serves as first line therapy to re-train pelvic floor coordination, rectal sensation and strengthening pelvic floor muscle. The aim of this study is determining the efficacy of BFT in our centre. MethodsThis is a retrospective observational cohort study of patients attended biofeedback therapy session from January 2013 to December 2018. Descriptive statistic was used to analyse the data. ResultTotal 99 patients with mean age of 44.6 ± 18.1 with female 56% (n = 55) and male 44% (n = 44) attended BFT session. Overall, 77 had CC (77%) and 23 (23%) had FI. Mean number of sessions was 11.8. Overall improvement rate 42 (42%), no improvement 32 (32%) and defaulted 26 (26%). In patients with CC, 32 (41.6%) had improvement in symptoms, 23 (29.9%) had no improvements, 22 (28.6%) defaulted BFT.Patients with FI, 7 (30.4%) had Obstetric Sphincter Injury, 7 (30.4%) had traumatic anal injury, 3 (13.0%) has Low Anterior Resection Syndrome, 2 (8.7%) had sphincter injury following anal sepsis, 2 (13.0%) had rectocele repair and 1 (4.3%) were idiopathic. 9 patients (39.1%) had stoma created. Overall response rate was: 10 patients (43.5%) had improvement in symptoms, 9 patients (39.1%) had no improvement, 4 patients (17.4%) defaulted therapy. ConclusionOur outcome rate is lower compared to published due the limited access and logistic restrictions. This issue should be given great consideration such as broadening the service and training.

“From hell to healed” – A qualitative study on women’s experience of recovery, relationships and sexuality after severe obstetric perineal injury

ObjectiveFew studies have investigated women’s experiences of daily life after childbirth complicated by obstetric anal sphincter injury (OASI). The aim of the present study was to explore experiences related to recovery, sexual function, relationships and coping strategies among women affected by OASI. MethodsIn-depth interviews were conducted using a purposive sample of 11 women affected by OASI. Women were interviewed 1–2 years after their first childbirth. Inductive qualitative content analysis was applied. ResultsThe theme “From hell to healed” illustrates women’s experiences of recovery, relationships and sexual function after OASI. Three categories addressing women’s perceptions emerged: “Challenged to the core”, “At the mercy of the care provider” and “For better or for worse”. Support from partners and family and comprehensive care were important elements for the experiences of coping and healing from OASI. Elements that negatively influenced women’s experiences were the pain and physical symptoms of pelvic floor dysfunction, normalization of symptoms by heath care providers, and unrealistic expectations about how this period in life should be experienced. ConclusionOASI greatly affects women’s experiences of their first years with their newborn child, relationships, social context and sexuality. For some women, OASI negatively affects everyday life for a long period after childbirth. However, others heal and cope quite quickly. Health care professionals need to identify and pay attention to women with persisting problems after OASI so that they can be directed to the right level of care.

Tocophobia

ABSTRACT Introduction Fear of childbirth is common during pregnancy and is believed to be the most common underlying reason for requesting a caesarean section without medical indication. Despite the fact that 17%-20% of all pregnant women report extreme fear of birth, named tocophobia, in ICD -10 International Classification for Disease-10 revision – ICD-10,) there is not established diagnose Tocophobia, which can also occurs in non-pregnant women and in men. Primary tocophobia may have its onset in adolescence, affecting nulliparous women to such degree that some women never bear a child. They also describe sexual dysfunction as vaginismus and non-consummation. Secondary tocophobia may be associated with a previous traumatic birth experience such as stillbirth. Tocophobia is not just associated with antenatal psychological morbidity, but also raised rates of postnatal depression, impact on the mental well-being of the baby for life, increased length of labour, lower birth weights and increased prevalence (8%) of admission to neonatal intensive care. They can have feelings of isolation, guilt and shame, difficulties to prepare for birth. They may have sleeplessness, nightmares, stomachaches and depression with anxiety that can leads to panic attacks. Women may also be concerned with pain, their own incapability, possible obstetric injuries, lack of control, lack of partner or family support, and loss of their baby. The interventions included psychosexual education, cognitive behavioural sex therapy. Therapeutic interventions reduce the number of women who go on to have caesarean birth. Tocophobia is a common condition with both acute and chronic implications for the welfare of mothers and babies. It can cause not only mental but also physical morbidity and needs a clear both plan for the care of women and her specific fears. Objective Couple has started with couple sex therapy for his problems with erection before they have children. They are married; they have already two children (5y, 3y). She has recently discovered that she is pregnant for the third time and she is in gestational week 8. As nulliparous woman, she has developed sever tocophobia. She has intensive therapy with clinical psychologist through all first pregnancy time, but she still developed minor postpartum depression but without any need for antidepressants. Methods We present a case of a 40-years old woman with sever tocophobia and the results of the treatment interventions. Results Treatments include sensitive psychosexual education about the birth process, development of problem-solving skills, teaching coping strategies for labour. Conclusions Tocophobia is a common condition with both acute and chronic implications for the welfare of mothers and babies. It can cause not only mental but also physical morbidity and needs a clear both plan for the care of women and her specific fears. Disclosure Work supported by industry: no.

Buccal Mucosal Grafts as a Novel Treatment for the Repair of Rectovaginal Fistulas: Protocol for an Upcoming Prospective Single-Surgeon Case Series.

BackgroundRectovaginal fistulas (RVFs) are abnormal communications between the rectum/anus and the vagina. They are most frequently formed a result of obstetric injury and have deleterious effects on patients’ quality of life. Despite several treatment modalities, RVFs remain difficult problems to manage, and many patients fail multiple attempts at surgical repair. Buccal mucosal grafts (BMGs) may be a solution to this problem. A BMG is an oral mucosal tissue harvested from the inner cheek. There are 2 case reports that describe the successful use of BMGs in the repair of RVFs.ObjectiveOur objective is to validate these findings with a prospective case series while also addressing the key issues of indication, technical details, procedure safety, and short-term outcomes.MethodsA prospective single-surgeon case series will be undertaken at a university-affiliated academic tertiary care hospital in Calgary, Alberta (Canada). The estimated recruitment is between 3 and 5 patients. Patients will undergo surgical repair of their RVFs with an autologous BMG. Data on patient characteristics, fistula characteristics, and surgical variables will be collected and analyzed prospectively. The primary outcome is fistula closure. This study has been approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB20-1123).ResultsTwo previous case reports have described the successful use of BMGs in the repair of RVFs. We have received ethics approval to attempt to validate these findings through a prospective case series.ConclusionsRVFs cause significant patient morbidity and are difficult problems to manage. Bolstered by the successful use of BMGs in urologic surgery and the previously published case reports demonstrating success in RVFs, we believe that BMGs may be a solution to RVFs.International Registered Report Identifier (IRRID)PRR1-10.2196/31003

Management and outcomes of anal sphincter injuries: A retrospective cohort study

Background/Aim: Anal sphincter injury (ASI) is a clinical condition that causes anal incontinence and can severely impair an individual’s quality of life. Overlapping sphincteroplasty (OSP) is the most preferred surgical method for repairing ASI. The present study aimed to discuss the demographic and clinical characteristics of patients who underwent ASI surgical repair in light of the current literature. Methods: Patients in two groups; males and females, who underwent an operation for grade 3-4 ASI in the General Surgery Clinic at Ataturk University between 2010 and 2021 were retrospectively analyzed. The severity of anal incontinence and quality of life post-operatively using the Wexner score were evaluated. For evaluating post-operative complications, the Clavien–Dindo Classification was used. Results: Over 12 years, 34 adult patients with a mean age of 35.8 (22–66) years underwent ASI surgery, namely 23 (67.6%) women and 11 (32.4) men. Considering the patients’ etiopathogenesis, obstetric injuries (55.9%) were the most common cause of ASI. All patients underwent overlapping sphincteroplasty (OSP), while 20.6% also underwent protective stoma. According to the Centers for Disease Control and Prevention (CDC), four patients were classified as Grade 1, four as Grade 2, seven as Grade 3 and one as Grade 5. At a mean follow-up of 35.8 months, the mean Wexner score was 3.59 and the success rate was 88.2% (P=0.445). Males had a longer average hospital stay (P=0.021) and a higher Wexner score (P=0.445), whereas females had a greater complication rate (P=0.388). The quality of life was high, but the Wexner scores were low in all patients. Conclusion: ASI most commonly occurs in women during childbirth. OSP has a high success rate, and opening a diverting ostomy when needed further increases this rate. The Wexner score is a simple and useful system for assessing anal incontinence.

Multidisciplinary minimally-invasive approach to complex vesicovaginal fistula repair

This video's objectives are to demonstrate the techniques and decision process used in the approach to a complex vesicovaginal fistula resulting from obstetric injury, after previous attempts at repair had failed. Our patient was referred from an outside institution to us. At emergent cesarean delivery at 24 weeks, hemoperitoneum, uterine rupture, and placenta percreta were found. During hysterectomy, the right ureter was ligated and the posterior wall of the bladder sustained large cystotomies. Urology repaired the injury, reimplanted the ureter, and placed a right ureteral stent, but the patient developed a vesicovaginal fistula and left ureteral obstruction. Ten months after diagnosis, it was repaired using a robot-assisted laparoscopic approach. This required bilateral ureteral re-implantation and omental flap. Unfortunately, this repair broke down, and testing was concerning for vesicovaginal and left ureterovaginal fistula, high at the vaginal apex. The patient was referred to our institution for our attending surgeon's expertise in fistula repair. Takeaways from this video presentation include: careful delineation of genito-urinary anatomy, vaginal approach, optimization of visualization, wide mobilization of tissue around the defect, watertight closre, meticulous multilayer closure, and aggressive management of infection.

Neurologic Complications of Obstetric Anesthesia.

The advantages of neuraxial anesthesia over general anesthesia in the obstetric population are well established. Some neurologic conditions have the potential to lower the safety threshold for administration of neuraxial anesthesia, whereas others require special consideration before using general anesthesia. The aim of this article is to help neurologists determine when neuraxial anesthesia can be safely administered and when it is inadvisable. Neuraxial anesthesia can usually be given safely in most pregnant patients with neurologic disease. Patients with mass lesions causing increased intracranial pressure or spinal tumors at the site of neuraxial needle placement and patients on anticoagulant medication are the exceptions. Post-dural puncture headaches and obstetric nerve injuries are the most common complications of neuraxial anesthesia and resolve in most patients. Other complications, including epidural hematoma, meningitis, and epidural abscess, are rare but devastating. This article provides a review of neurologic diseases that may affect the decision-making process for anesthesia during delivery. It discusses the neurologic complications that can occur because of obstetric anesthesia and how to recognize them and describes obstetric nerve injuries and how to distinguish these relatively benign injuries from more serious complications.

Obstetric perineal trauma: a modern view of the problem. A prospective study

Trauma to the perineum during childbirth is still a common obstetric problem. The question of etiology and risk factors is still extremely debatable. The high risk of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of this complication of childbirth, which seems to be the main reserve for reducing future pelvic floor insufficiency and associated pathological conditions.
 Background. Perineal trauma during childbirth is still a common problem in obstetrics. Also, a high percentage of long-term consequences of perineal injuries creates the need for timely prediction and effective prevention of perineal trauma during childbirth, which is relevant today.
 Aim. To identify the main predictors of the risk of developing obstetric perineal injury.
 Materials and methods. We conducted a prospective randomized study between September 2020 and January 2022, which included 110 pregnant women. The observation of the patients began from the day of the first visit to the antenatal clinic and throughout pregnancy and the postpartum period, much attention was paid to a comprehensive perineological examination.
 Results. In group 1, a large number of grade I and II tears (n=37, 33% and n=24, 29%) were noted, and grade III tears were completely absent. In group 2, there were grade III perineal tears, the frequency was (n=5, 2.1%), but still their number was inferior to grade I and II tears (n=10, 26% and n=15, 14%). In group 3, the analysis showed a low frequency of perineal tears of I and II degrees (n=8, 11% and n=17, 18%) and a number of tears of degree III comparable to group 2 (n=8, 2.6%). Episiotomy in all groups was carried out in the range from 7 to 9%, strictly according to obstetric indications.
 Conclusion. According to the data obtained, the most significant clinical and anamnestic predictors of obstetric perineal trauma were: frequent abortions in anamnesis, chronic diseases of the ENT organs and the urinary system, vaginal dysbiosis (nonspecific vaginitis, bacterial vaginosis), changes in the pH of the vaginal environment, low tone of the perineum, the presence of scar on the perineum.

Incidence and risk factors of perineal tears of pregnant women delivering at a midwife obstetric unit South Africa

Aim: To estimate the incidence and risk factors for perineal tears of low-risk pregnant women delivering at a midwife obstetric unit.
 Methods: A retrospective study performed on perineal tear during childbirth from birth register at midwife run unit in Durban municipality, South Africa between January 2018 and October 2019. Risk factors were studied and bivariate and logistic regression done. Results are expressed with adjusted odds ratios (OR) and p-values <0.05 are considered significant.
 Results: A total of 1578 women had singleton vaginal childbirths. Half (50.6%) of them have perineal tears. The incidences of episiotomy, combined first-and second, and third-and fourth- degree (OASI) tears are 24.3%, 25.1% and 1.1% respectively. Risk factors for any perineal tears are younger mothers (teenage OR=2.9, 20-24 years OR=2.2), primipara (OR= 15.8), received antenatal care (OR=.47) and gestational age (GA) (<32 weeks OR=.05). The risk factors for episiotomy are; teenage (OR=5.4), ages 20-24 years (OR=4.2), ages 25-29 years (OR=3.0), primipara (OR=12.4), GA (£32 weeks OR=.16), GA 33-36 weeks (OR=.6) and having antenatal care (OR=.41). Birth weight <2.5 kg and between 2.5-3.0 kgs (OR=.014) and (OR=.09) are protective for OASI.
 Conclusions: Risk factors for the perineal injuries are similar to those previously reported in other studies. Training of midwives on perineal care and selection for undertaking episiotomy is urgently needed to improve maternity services at the midwife obstetric unit. Identification of those at risk may reduce obstetric perineal injury.

Obstetrical Soft Tissue Trauma during Spontaneous Vaginal Birth in the Romanian Adolescent Population-Multicentric Comparative Study with Adult Population.

Romania is a country with high rates of adolescent births, associating scarce comprehensive obstetrical management with this specific population. This research aims to assess soft tissue trauma after vaginal birth in teenage mothers compared to their adult counterparts. A retrospective case-control study was conducted for one year in two hospitals. All vaginal deliveries were considered; the age cut-off value was considered at 20 years old for case and control groups. Lacerations were divided into three subgroups, considering the involved anatomical region; group I: labial and periurethral lacerations, group II: vaginal and perineal lacerations, and group III: cervical lacerations. There were 1498 women included in the study: 298 young mothers and 1200 adults. Teenagers were more likely to have an episiotomy during vaginal delivery compared to adult women: 56% versus 26.7% (p = 0.00, Pearson Chi-square) and a 1.89 times increased risk for developing additional group II lacerations: p = 0.01, Pearson Chi-square test with Bonferroni correction: OR = 1.89, 95% CI: 1.18–3.02. Group II lacerations were the most frequent type of birth trauma in both study groups. Fetal weight ≥4000 g was associated with a two times higher risk for vaginal and perineal lacerations when age criterion was not considered (OR = 1.98, 95% CI: 1.13–3.47, p = 0.01). The incidence of group I and II lacerations increased with age: from 0% and 9.1% between 10 and 14 years old to 6% and 26.2% between 18 and 19 years old. All groups of lacerations were more often identified in the case group, compared to the adult group. Fetal macrosomia and spontaneously ruptured membranes at admission could not be documented as risk factors for obstetrical injury in young mothers. Episiotomy performed in teenagers was not a protective procedure for group II lacerations.

Gracilis Muscle Interposition: A Valuable Tool for the Treatment of Failed Rectovaginal Fistula Repair Due to Obstetric Injury: Single Center Experience

Gracilis Muscle Interposition: A Valuable Tool for the Treatment of Failed Rectovaginal Fistula Repair Due to Obstetric Injury: Single Center Experience

A retrospective case series on transvaginal repair of rectovaginal fistula performed by a urogynaecology operative team in Australia.

Rectovaginal fistula (RVF) is an abnormal epithelialised connection between the rectum and vagina. It is a common condition in limited resource settings and is caused almost exclusively by obstetric injury. In contrast, RVF is uncommonly seen in high resource settings. This study aims to review the aetiology and effectiveness of RVF management in the high resource setting, identifying predictors for repair success and long-term outcomes. A retrospective case series study of patients who underwent transvaginal RVF repairs at two secondary healthcare facilities over a 14-year period by one operative group. A total of 41 patients underwent 46 surgical repairs. All patients presented with flatal and/or faecal incontinence and aetiology was identifiable in 78.0% (n=32). Obstetric cause was implicated in 26.8% (n=11) and other causes include 26.8% (n=11) from vaginal and abdominal surgery, 14.6% (n=6) from perianal abscess, 7.32% (n=3) as complications of Crohn's disease and 2.44% (n=1) as a complication of a cube pessary. Fistula was cured in 38 of 41 cases (92.7%) with a primary repair closure rate of 80.5% (n=33). Post-operative symptoms were limited to flatal incontinence in 4.88% (n=2), faecal incontinence in 2.44% (n=1), and persistent perineal pain in 7.32% (n=3). The success of the surgical repair was not significantly impacted by fistula size, aetiology, presence of a stoma for diversion, history of prior repair, duration since RVF formation or repair technique. This review identifies aetiology for RVF in the high resource setting and highlights the role of earlier surgical repair to minimise patient morbidity with good success in closure and reduction of post-operative symptoms.

Lotus petal flap for unusual indication: A recto-vaginal fistula with perineal defect after vaginal delivery.

Introduction and importanceThree to five percent of vaginal deliveries are complicated by third or fourth degree perineal laceration. Misdiagnosed perineal injuries may be associated with a poor sexual and psychological prognosis. Management of old perineal tears and laceration is challenging with a high failure rate. In such condition, interposition tissue technic or local flap can be a good surgical alternative. Lotus petal Flap, usually indicated in management of large perineal defect in gynecological oncology can be used.Case presentationWe report a case of 32-year-old women presenting complex and relapsed perineal fistula after vaginal delivery associated with perineal defect treated by lotus petal flap with a good outcome.DiscussionPerineal defects are commonly encountered after oncologic, traumatic or infectious perineal excisions and described as a challenging situation. In case of perineal defects after obstetrical tears, no validated surgical filler technics are recommended. Inspired from oncologic surgical technics to fill perineal defects, Lotus Flap can be used. Its advantages are to mobilize a satisfactory tissue volume to fill important perineal defect compared to the small bulbocavernous flap with a hidden scar comparing to gracilis muscle flap. This technic is associated with a good sexual and self-imaging outcome.ConclusionLotus petal flap may be required as a solution to manage perineal defect in case of perineal fistula. This technique provides aesthetic and good results for perineal reconstruction.

Women’s experiences of the injury, recovery and desire for rehabilitation after a second-degree vaginal tear—a qualitative study

Introduction and hyposthesisEighty-five percent of all vaginal deliveries cause some form of obstetric tear injury. To our knowledge, there are no studies exploring experiences after second-degree tear. Therefore, our study aimed to investigate the experiences of a second-degree vaginal tear regarding aspects of the recovery and need for healthcare and rehabilitation.MethodsIndividual semi-structured interviews were performed and analysed with a qualitative, inductive descriptive approach.ResultsA group of 18 women with a second-degree vaginal tear after delivery were included. Four main categories with associated subcategories were found: (1) feeling uncertainty, with subcategories: not knowing what is normal, concern, confusion and uncertainty regarding pelvic floor muscle training; (2) feeling of security, with subcategories: I have no/I can handle the symptoms, trust in the healthcare system and I have sufficient knowledge; (3) not prioritizing myself, with the subcategories: I cannot find time and others have bigger problems; (4) lack of trust in healthcare providers, with the subcategories: feeling forgotten, not being taken seriously, distrust of the competence of the healthcare providers and resignation.ConclusionWomen who suffer from a second-degree vaginal tear after pregnancy can feel safe when needs are met but uncertainty is also common when available healthcare and information are perceived as insufficient. The women also feel uncertainty about what is normal after the tear and how to perform pelvic floor exercises.Trial registrationThis trial was registered in “FoU in Sweden” (Research and Development in Sweden). Registration number: 214591.

Treatment of Pelvic Organ Prolapse with “Vaginal Laser”– A Mini-Review of the Literature

It is not yet possible to prevent the aging processes. Like other several risk factors (such as genetics, race/ethnicity, gender, obstetrical and gynaecological injuries, smoking, obesity) the aging also causes weakening of the pelvic floor connective tissue/ collagen and leads to pelvic organ prolapse (POP)...

Влияние акушерского геля на процесс и продолжительность родов

В статье рассмотрена проблемы слабой родовой деятельности, акушерского травматизма, увеличение числа оперативных вмешательств. Проведено исследование эффективности и безопасности акушерского геля Dianatal при его применении в родах.

Neuromuscular Electrical Stimulation Improves Muscle Strength, Biomechanics of Movement, and Functional Mobility in Children With Chronic Neurological Disorders: A Systematic Review and Meta-Analysis.

Chronic neurological disorders (CNDs) generally produce deleterious effects on the musculoskeletal system and can affect physical activity and increase sedentary behavior in children, hindering the execution of training programs and the attainment of a correct dose of exercise. The purpose of this systematic review was to analyze the effect of neuromuscular electrical stimulation (NMES) on skeletal muscle and then on biomechanics of movement, functional mobility, strength, spasticity, muscle architecture, and body composition of children and adolescents with CNDs and chronic diseases. The search was conducted in April 2020 in PubMed, MEDLINE, Scopus, the Cochrane Library, and Web of Science, without publication period restriction. Publications investigating the effect of NMES on children and adolescents with CNDs and other chronic diseases were independently selected by 2 researchers. One author independently extracted data from the studies selected, and a second author cross-checked. Eighteen studies with 595 participants aged between 3 and 14years were included. Quality assessment showed that 50% of the studies presented a low risk of bias. The pooled effect of NMES on gross motor functional measure, calculated as a standardized mean difference using a random effects model, was 0.41 (95% CI = 0.19-0.64). The use of NMES programs for children diagnosed with cerebral palsy, spinal muscular atrophy, and obstetric injury of the brachial plexus was effective in improving muscle strength, biomechanics of movement, and functional mobility. NMES can be a useful tool to prevent the reduction of mobility that results from CNDs.

Impact of residual defect of anal sphincter on patient’s quality of life

The aim of this retrospective study is to correlate the presence of residual anal sphincter defect with the quality of life of patients after vaginal delivery complicated with obstetrical anal sphincter injury. Patients diagnosed with obstetrical anal sphincter injury are dispensed at our urogynecological unit, with a mean follow-up period of 37 months. Two investigators blinded to the results of clinical symptoms evaluated archived ultrasound volumes taken for the presence of residual anal sphincter defects that were later correlated with the St. Mark’s Incontinence Score. The group comprises of 181 patients diagnosed with an obstetrical anal sphincter injury who underwent ultrasound examination of anal sphincter at three post-partum months. The questionnaires were completed by 118 patients (65.2% of all patients). A residual sphincter defect was diagnosed in seven cases (5.9%). In the group with residual defects, fecal urgency (lack of ability to defer defecation) was present in 57.1%. In the group without residual anal sphincter defects, fecal urgency was present in 12.6%. This difference is significant (< 0.001) with the contingency coefficient 0.291. In conclusion, the presence of residual anal sphincter defect increases the probability of fecal urgency.

Diagnosis and treatment of faecal incontinence – the current state of knowledge, literature review

Incontinence significantly affects the daily functioning of patients and can severely deteriorate their quality of life, leading to social disability. The most common causes of gas and faecal incontinence include obstetric injuries (mechanical trauma to the sphincter muscles or stretching of the pudendal nerve during vaginal delivery) and complications after anorectal procedures. The incidence of faecal incontinence is estimated by various authors between 2.2 and 25%. The problem affects all age groups, but mainly the elderly, with higher rates among women than men. The paper presents a review of diagnostic and therapeutic methods for incontinence based on the latest reports. Most researchers agree that, except for extensive sphincter injuries, conservative methods are the mainstay treatment for faecal incontinence, while instrumental or surgical procedures are used in the event of their failure. Despite the multitude of therapeutic methods for this difficult disease, there is no ideal procedure as the aetiology of incontinence is usually multifactorial, hence the therapeutic management should be incorporated on several levels. Treatment should be performed in a centre dedicated to proctological patients, equipped with appropriate diagnostic tools and specialist personnel.